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I make no apology for the length of the article linked to this blog post. A month after it was posted in the LRB nothing has fundamentally changed, it’s just that the media feeding frenzy has moved on to Brexit.

Diary – Lana Spawls 04.02.2016

Antidiuretic hormone, also known as vasopressin, is released when levels of water in the blood become too low – when you’re dehydrated. It tells the kidneys to reabsorb water back into the bloodstream. For a while this keeps you going: it was working overtime in my system when I found myself ten hours into a Saturday shift at the hospital, without a drink or a break since my breakfast cup of tea at home. It wasn’t a shift crammed with life or death emergencies: I had a clinic in A&E reviewing patients with minor injuries, two ward rounds and a never-ending list of jobs to do. Each time I crossed one off I’d receive a bleep on my pager: another sick patient to review, scans to order, bloods to take, prescriptions and discharge letters to write. At weekends, junior doctors cover care across the whole hospital. I’d been assigned three wards. I managed to make it to the canteen, and a first mouthful of beans, before the familiar jangling started again. I went to the nearest phone to dial in: a prescription of intravenous paracetamol needed changing to oral. I added it to my list and went back to eat. A few more mouthfuls and it went off again. There was no answer when I dialled back: apparently the 15 seconds it took me to reach the phone was too long and the caller had rushed off. I added the number to my list. I’d call them back.

Four days later I’m working my ninth day in a row. On normal weekdays I’m only responsible for the forty or so patients under the care of my usual team. Usually I would split this with another first year foundation (FY1) doctor, but he’s on holiday so it’s down to me. From 4 p.m. until 9 p.m. I’m on call looking after patients from four different surgical teams. About half an hour before I should finish I’m bleeped to examine a patient who has just arrived on the ward and is due to go for surgery the next day: a teenage girl with a brain tumour. Until she has surgery we won’t know if it’s cancerous or benign. She and her mum look nervous. We talk about her older brother who’s just had a baby daughter, her favourite subjects at school (art and drama) and what she wants to do when she grows up (be a dancer). Before surgery she needs blood tests so I go to find a tourniquet, needles, bottles and gauze. It’s a ward that I don’t usually work on, and every ward keeps its equipment in a different place. On top of this, the printer for the blood bottle labels isn’t working. It takes me nearly an hour, including a trip to another ward, to get everything ready. The patient tells me how difficult – and painful – it was the last time someone took her blood. I tell her how important the tests are and how quick I will be, but now I’m getting nervous too. My first attempt is fruitless and she’s not keen to let me try again, but eventually I persuade her. This time I find a better vein, a little deeper but more bouncy, and get it straightaway. She stops crying to tell me it wasn’t actually that bad. When I leave work, nearly two hours late, the lights have been stolen from my bike, which I’d left in front of the hospital, so I cycle home in the dark. At least it’s not raining. I never find out what happened to the girl.